DVT prophylaxis for MRI

[boysetsfire]

We're starting to do alot of anesthesia for adult MRI, as I'm sure alot of you are, and sometimes the cases go well in excess of 2 hours. Per the surgical protocol, these patients should get some sort of DVT prophylaxis such as SCD's or subQ heparin if undergoing a surgical procedure, but since there is no surgical insult during an MRI, I'm wondering what sort of DVT prophylaxis, if any, you folks are doing at your hospitals. The SCD machine is not MRI safe, so trying to research an alternative device...Thanks

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[proman]

Why do anything? As you stated, surgical prophylaxis is indicated for patients undergoing surgery which these are not.

 

[militarymd]

Why do anything? As you stated, surgical prophylaxis is indicated for patients undergoing surgery which these are not.

Do we not provide DVT prophylaxis for patients who are mechanically ventilated in the ICU even if they are not having a procedure?

Let's say for something like someone who has bad COPD and requires sedation and ventilatory support for a few days.

 

[Arch Guillotti]

We're starting to do alot of anesthesia for adult MRI, as I'm sure alot of you are, and sometimes the cases go well in excess of 2 hours. Per the surgical protocol, these patients should get some sort of DVT prophylaxis such as SCD's or subQ heparin if undergoing a surgical procedure, but since there is no surgical insult during an MRI, I'm wondering what sort of DVT prophylaxis, if any, you folks are doing at your hospitals. The SCD machine is not MRI safe, so trying to research an alternative device...Thanks

nothing

 

[Mman]

Do we not provide DVT prophylaxis for patients who are mechanically ventilated in the ICU even if they are not having a procedure?

Let's say for something like someone who has bad COPD and requires sedation and ventilatory support for a few days.

being in MRI for 2 hours is a substantially lower DVT risk than 24-48 hours on the vent in a critically ill ICU patient.

Do we provide DVT prophylaxis to patients asleep at home in bed? I mean they might be immobile for 6-10 hours.

 

[geogil]

being in MRI for 2 hours is a substantially lower DVT risk than 24-48 hours on the vent in a critically ill ICU patient.

Do we provide DVT prophylaxis to patients asleep at home in bed? I mean they might be immobile for 6-10 hours.

That's why I take lovenox before going to bed. Nobody wants to wake up with a PE.

 

[Arch Guillotti]

That's why I take lovenox before going to bed. Nobody wants to wake up with a PE.

I start an IV since I am NPO.

 

[militarymd]

being in MRI for 2 hours is a substantially lower DVT risk than 24-48 hours on the vent in a critically ill ICU patient.

Do we provide DVT prophylaxis to patients asleep at home in bed? I mean they might be immobile for 6-10 hours.

video tape yourself while you are asleep...and if you truley are immobile for 6 - 10 hours.....post the video...I'll send you $20,000. tax free..

 

[militarymd]

I start an IV since I am NPO.

you should...because you are a dick.

 

[proman]

video tape yourself while you are asleep...and if you truley are immobile for 6 - 10 hours.....post the video...I'll send you $20,000. tax free..

Critically ill patients are in another category. Immobility by itself doesn't lead to DVT, otherwise all the paraplegics out there would DVTs (beyond the acute phase). People flying extremely long flights don't get DVTs except in very rare instances.

What is the risk of DVT in an anesthetized patient immobile for 2 hours undergoing a procedure that induces no tissue injury, no acute phase reaction, no pro-inflammatory cytokine production? Probably the same as riding shotgun in a car for 2 hours. The scenario's only risk is from some venous stasis after induction.

 

[pgg]

I start an IV since I am NPO.

But do you measure your urine output to make sure you're producing 0.5 mL/kg/hr?

The SCD machine is not MRI safe, so trying to research an alternative device...

If someone with more authority than sense has decided you really must have DVT prophylaxis for these, it'd probably be easier to find some minimally compliant tubing to connect the MRI-safe leg wraps to your MRI-notsafe machine on the other side of the room. For a consultant fee of $20K I'll make one for you.

 

[pgg]

video tape yourself while you are asleep...and if you truley are immobile for 6 - 10 hours.....post the video...I'll send you $20,000. tax free..

This thread's gonna make me some spendin' money.

Sprinkler tubing from Home Depot and a few minutes with a video editor and bam!

 

[jwk]

The simplest thing is not to get involved in MRI anesthesia cases. We never do MRI cases - ever. No MAC, no GA, nada, nothing.

 

[DScully]

But do you measure your urine output to make sure you're producing 0.5 mL/kg/hr?

He probably has a self-programmed Alaris pump that delivers zofran 30mins before the alarm goes off...

 

[Idiopathic]

The simplest thing is not to get involved in MRI anesthesia cases. We never do MRI cases - ever. No MAC, no GA, nada, nothing.

amazingly, this is the least helpful post in this thread.

i dont do this but i can see the justification, especially for "high risk" patients.

 

[urge]

We're starting to do alot of anesthesia for adult MRI, as I'm sure alot of you are, and sometimes the cases go well in excess of 2 hours. Per the surgical protocol, these patients should get some sort of DVT prophylaxis such as SCD's or subQ heparin if undergoing a surgical procedure, but since there is no surgical insult during an MRI, I'm wondering what sort of DVT prophylaxis, if any, you folks are doing at your hospitals. The SCD machine is not MRI safe, so trying to research an alternative device...Thanks

Give them some heparin if it makes you happy. You can even give it iv if you want. They will not bleed.

I'm not used to giving anything.

 

[TrustMe]

The simplest thing is not to get involved in MRI anesthesia cases. We never do MRI cases - ever. No MAC, no GA, nada, nothing.

Very jealous. I wish we never did these. One of the most painful situations in residency. NOT WORTH THE HASSLE!!!!!!!

 

[MTGas2B]

If you give them enough heparin it will make it easier to spot the head bleed.

 

[Per4mer8]

If you give them enough heparin it will make it easier to spot the head bleed.

 

[Mman]

video tape yourself while you are asleep...and if you truley are immobile for 6 - 10 hours.....post the video...I'll send you $20,000. tax free..

Don't need the money. But seriously, I've seen drunk people unconscious in the same position for > 6 hours. They don't get DVTs. Of course I'm aware people move while they sleep.

But I'm sure you are equally aware that surgery creates an inflammatory, pro-coagulant reaction in the body that can lead to DVT in susceptible patients. Remember Virchow's triad? If the MRI patient isn't already on coumadin or lovenox, they really shouldn't be needing DVT prophylaxis for a 2 hour MRI.

 

[fakin' the funk]

The simplest thing is not to get involved in MRI anesthesia cases. We never do MRI cases - ever. No MAC, no GA, nada, nothing.

Meaning, at your institution, the radiologists/nurses do sedation for MRI or they get nothing?

 

[fakin' the funk]

Remember Virchow's triad? If the MRI patient isn't already on coumadin or lovenox, they really shouldn't be needing DVT prophylaxis for a 2 hour MRI.

You mean...the one that includes stasis as a component of DVT risk?

 

[Mman]

You mean...the one that includes stasis as a component of DVT risk?

Exactly. You might also recall it requires much more than just stasis. Get it? A healthy individual that isn't hypercoagulable and isn't having tissue/endothelial injury isn't going to spontaneously form clots in their legs. The human body doesn't work that way.

 

[BLADEMDA]

Exactly. You might also recall it requires much more than just stasis. Get it? A healthy individual that isn't hypercoagulable and isn't having tissue/endothelial injury isn't going to spontaneously form clots in their legs. The human body doesn't work that way.

What about SCDs for cataract surgery? Seems like over-kill to me.

What about DVT prophylaxis for cysto/stent placement on an ASA2 going home in an hour?

Some hospitals have gone over board on this

 

[Mman]

What about SCDs for cataract surgery? Seems like over-kill to me.

What about DVT prophylaxis for cysto/stent placement on an ASA2 going home in an hour?

Some hospitals have gone over board on this

I agree that some hospitals have gone overkill. I can't recall our exact criteria, but I know we skip it on most minor cases that are going to last 30 minutes or less.

 

[Arch Guillotti]

The simplest thing is not to get involved in MRI anesthesia cases. We never do MRI cases - ever. No MAC, no GA, nada, nothing.

Some of us do not have this option. If you are asked to perform a service many groups will try and comply despite stretching staffing in a potentially resource intensive endeavor. I think flat out refusing to ever be involved in something as common as MRI scans doesn't make any sense. Especially for peds.

 

[jwk]

Some of us do not have this option. If you are asked to perform a service many groups will try and comply despite stretching staffing in a potentially resource intensive endeavor. I think flat out refusing to ever be involved in something as common as MRI scans doesn't make any sense. Especially for peds.

Ah, I guess I should have qualified my opinion.

Ours is not a staffing issue - we provide coverage for interventional radiology every day. We were asked by our hospital years ago to provide coverage for MRI. We told them we would only do it if they provided a full complement of MRI-compatible equipment - machine, monitors, equipment, everything. They turned us down so we simply won't go. I fully agree that in some places, particularly for peds, that would not be an option, but fortunately we have two world-class peds hospitals in town to do all that fun stuff.

 

[pgg]

I think flat out refusing to ever be involved in something as common as MRI scans doesn't make any sense. Especially for peds.

Especially since at some point there's probably an AMC looking to undercut the group's contract, and they'll agree to do everything. We're a service specialty.